Background:
Population ageing is a major public health concern in Singapore, where one in four residents will be aged 65 years and above by 2030. Older adults living alone face heightened risks of loneliness, social isolation, and reduced quality of life. CareLine, a telephone-based befriending service, was established to provide regular check-ins, reassurance, and linkages to health and social resources. This study presents the first empirical evaluation of CareLine, focusing on the user profile, service utilisation, and participants’ perceptions of value.
Approach:
A cross-sectional telephone survey was conducted with 708 CareLine users between November 2024 and March 2025, complemented by analysis of call log data from 2017 to 2023. The survey included validated measures of loneliness (UCLA 3-item scale) and quality of life (EQ-5D-3L), alongside questions on trust and service perceptions. Data were analysed descriptively and through multivariable regression to identify factors associated with loneliness, service perceptions, and health-related quality of life.
Results:
Respondents were predominantly female (68.7%) and Chinese (74.4%), with a mean age of 70.9 years. Most reported low levels of loneliness, though 8.4% met the threshold for loneliness. Quality of life was moderate, with a mean EQ-5D index of 0.653 and EQ-VAS of 7.05. Almost half of respondents expressed trust in CareLine and willingness to use it for emotional or practical support. Regression analyses revealed that non-Chinese respondents and those with more inbound calls reported higher loneliness, while lower EQ-5D index scores were associated with non-Chinese ethnicity, living with others, greater outbound call volume, and higher loneliness.
Implications:
This study highlights both the promise and limitations of telephone-based befriending services for older adults. CareLine users reported generally low loneliness and moderate quality of life, though important disparities emerged by ethnicity, living arrangement, and service utilisation. Findings underscore the need to strengthen trust, address psychosocial risk factors, and tailor service delivery to diverse groups. Insights from this evaluation can inform the optimisation and scaling of telehealth-enabled befriending models in Singapore and internationally.

Background
Older adults seeking government-subsidized long-term care have heightened vulnerabilities and often face barriers to accessing necessary support services, increasing the risk of emergency department (ED) visits and nursing home admissions. Social connections play an important role in supporting older adults to age in place, navigate health and social care services, and manage health crises, thereby potentially preventing avoidable ED visits and reduce nursing home entries. Understanding the relationship between social connectedness and these outcomes could help develop integrated care models that address social factors impacting older adults’ overall well-being and support their ability in ageing in place. This study aims to examine the association of social connectedness with ED visits and nursing home admissions for this vulnerable older population.
Approach
We analyzed retrospective cross-sectional data from 25,172 Hong Kong residents aged 60 and older interviewed in 2019, using the International Residential Assessment Minimal Data Set – Home Care Assessment (MDS-HC). Social connectedness was measured by two indicators: presence of lonely feelings and reduced social interaction (less participation in activities than 90 days before). Multivariate logistic regressions were conducted to estimate for the odds of emergency department visit and moving to nursing home within 2 years, adjusting for covariates.
Result
A total of 60% of the participants were female, with 35% aged 75 to 84 years and 41% aged 85 to 94 years. 41% were married and 72.2% lived at home. Approximately 23% reported feeling lonely, while 28% indicated reduced social interaction. Multivariate regression models identified cognitive function, dementia, and depression as health factors increased risk of ED visit, while ADL function, cognitive function, depression, and hypertension were linked to nursing home placement. Social factors including outdoor activity frequency and being alone duration everyday significantly influenced both outcomes.
Both loneliness (odds ratio, 1.16; 95% CI, 1.05-1.29; p<0.05) and reduced social interaction (odds ratio, 1.48; 95% CI, 1.35-1.63; p<0.001) independently associated with higher risk of emergency department (ED) visit after adjusting for each other and all covariates. Also, feeling lonely was associated with a greater risk of nursing home placement (odds ratio, 1.45; 95% CI, 1.31-1.59; p<0.001), independent of social interaction and other factors. However, no significant effect was found for the association between reduced social interaction and nursing home placement after adjusting for the effect of feeling lonely. This study found that feeling lonely and reduced social interaction independently associated with emergency department visit, while feeling lonely was an independent risk factor for nursing home placement.
Implications
Study findings underscore the importance of social connectedness in reducing emergency department visits and nursing home placement for older adults who are seeking government-subsidized long-term care. The design and assessment of integrated care models that valuing social connectedness, such as social prescribing strategies, have the potential to improve their health trajectories and prevent avoidable emergency visits. Additionally, by recognizing the relationship between loneliness and nursing home placement, this study emphasizes the necessity of co-producing solutions with older adults to address loneliness, thereby supporting their preference to age in place rather than in institutions.

Background

Community Hospitals in England are small local community-based hospitals located in mainly remote, rural and coastal locations. These local hospitals have a long tradition of providing community-based intermediate care through inpatient care, clinics, diagnostics and therapies. We wanted to identify recent changes and learn about the experiences of patients and communities.


Approach

The Community Hospitals Association (CHA), as a voluntary organisation is committed to promoting community hospitals, supporting staff, patients and communities.

We adopted a mixed method approach to determine how the model of the community hospital is evolving and how this has affected integrated working.

We adopted the classification system our CHA Department of Health 2008 Profiling Study to identify 2 models: Community Hospitals and Community Hubs. The updating and validation of this database was carried out using our membership database, internet searches of provider organisations, and verifications from members. We carried out detailed data analysis on a random sample of 176 community hospitals to identify the trend for community hospitals.

We selected a case study for each model to help to understand the partnerships in the models, and also to incorporate the experiences of people using the service. We regularly support local communities who want to be partners in designing their local services, and we wanted to evidence this community support in these case studies.


Results

Over the past 18 years the proportion of community hospitals with beds has reduced from 95% to 63%. This has created 2 models of community-based care – community hospitals and community hubs.

The case study of a community hub has shown that hubs have a role of health promotion and wellbeing, welfare, and citizen support. This is being achieved through integrated working with agencies such as voluntary agencies and community groups.

The case study of a community hospital shows the focus on clinical and intermediate care services. There is evidence of integrated working between acute and community hospitals as well as primary care and community hospitals.

Patient stories from individuals and “Leagues of Hospital Friends” in these case studies illustrate how these services meet the needs of local communities.


Implications

Community hospitals have been characterised as providing person-centred integrated care. In addition to the traditional community hospital, we now have community hubs. In combination they are demonstrating the positive impact of community-based care, designed around the needs of those who use the service and their local communities. This is vital for communities in remote areas who rely on being able to access local services. There is evidence of new partnerships being forged and integrated working extending across sectors and agencies in these models which are designed to meet the populations needs for health care and wellbeing. We continue to support members who are developing these models of community-based care, and share the learning across our network and our growing international network.

Background:
Individuals with diabetes and vascular disease face disproportionately high risks of avoidable hospitalizations, amputations, and long-term disability1. In Northwestern Toronto, an underserved community, these risks are compounded by systemic inequities, fragmented transitions between care settings, and limited access to vascular expertise. Addressing these complexities requires a proactive, integrated, and community-based approach prioritizing early intervention, coordinated care, and patient and provider engagement.

Approach:
The Lower Limb Preservation (LLP) Pathway was co-designed by Humber River Health’s (HRH) SCOPE and LTC+ programs with vascular specialists at OwnHealth to strengthen continuity of care across hospital, community, and long-term care (LTC) sectors. SCOPE and LTC+ are virtual, interdisciplinary programs that connect primary care providers and LTC clinicians to hospital and community resources, offering navigation support and care coordination to enhance outcomes and foster collaboration. A co-developed logic model and evaluation framework enabled data-driven improvement aligned with the Quintuple Aim, reflecting a shared commitment to equity, innovation, integrated care, and continuous quality improvement.

This innovative model embeds vascular expertise within community settings by incorporating hospital-based specialists with an interdisciplinary network, including nurse navigators, primary care providers, LTC clinicians, nurse practitioners, and chiropodists. This collaborative design emphasizes early detection, coordinated triage, navigation, and streamlined referrals to reduce delays and improve clinical outcomes for individuals with vascular wounds.

HRH’s and OwnHealth’s investment into the LLP Pathway reflect a commitment to coordinated, person-centred, and equitable care across sectors. This includes enhancing access to specialized vascular expertise within the community, team-based collaboration, outreach to underserved populations to support health equity and inclusion, data-driven improvement through the utilization of a logic model and evaluation framework, and capacity-building through tools, training, and support for community-based vascular wound management. This investment enables a shift from reactive hospital-based interventions to proactive community-based approaches to care that preserve function and prevent avoidable limb loss. Strategic partnerships with the Northwest Toronto Ontario Health Team further enhance system navigation, provider collaboration, and alignment with regional health priorities.

Results:
Through proactive, coordinated, interdisciplinary care, HRH’s LLP Program demonstrates reductions in major lower-limb amputations and limb preservation for patients at risk. Improved access to specialized vascular expertise—previously limited to acute hospitals—has reduced wait times and enhanced seamless care coordination across settings, decreased avoidable emergency department visits and hospitalizations, positively contributing to cost effective use of acute care resources, and patients’ experience and quality of life. Outreach to equity-deserving populations has expanded access to specialized care, closing long-standing gaps in limb preservation outcomes.

The LLP Pathway supports providers through timely consultations, educational resources, collaborative care planning, and wound management, reinforcing local capacity to manage complex patients in the community. Next steps include deploying patient experience surveys.

Implications:
This presentation will outline the LLP Pathway’s evolution, early results, and lessons learned, highlighting implications for future investments in prevention and community-based support. Grounded in population-level data, community partnerships, and continuous quality improvement, the LLP Pathway offers a scalable framework for integrated care systems that advance health equity, quality of life, and hospitalization avoidance.

References
1. Corhealthontario.ca. Available from: https://www.corhealthontario.ca/Ontario_Framework_for_Lower-Limb_Preservation-October-2021.pdf.